MEDICARE: JOSE NICOLAS FERNANDEZ BONILLA M.D., PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2088P0231X	Pediatric Urology Physician	60989886	WA

General Provider Information

NPI Number	:	1356506331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE NICOLAS FERNANDEZ BONILLA M.D., PHD

Provider Business Mailing Address
First Line	:	PO BOX 50095
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98145-5095
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 SAND POINT WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-3901
Country	:	US
Telephone Number	:	206-987-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2008
Last Update Date	:	07/29/2020

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